Individual
DR. NANCY JO EVANGELISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
10 CHURCH ST, ALFRED, NY 14802-1102
(607) 968-0616
(607) 587-9533
Mailing address
10 CHURCH ST, ALFRED, NY 14802-1102
(607) 968-0616
(607) 587-9533
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
009840-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11514985
CAHQ UNIVERSAL CREDENTIAL
NY
Enumeration date
03/13/2007
Last updated
07/08/2007
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